When I was a freshman in college and a psychiatrist at the school health center wrote me a prescription for antidepressants to treat what—in hindsight—seems like a pretty run-of-the-mill combination of homesickness and heartache, she explained that I was suffering from a biological disorder that required a biological treatment.

As I recalled that year later in my book, Coming of Age on Zoloft, the antidepressants seemed to brighten my mood. But the idea of myself as a person with a brain disease was anything but uplifting. I felt broken, and it seemed to me that anyone else who “knew” I used medication would see me in the same unflattering light.

For years, proponents of the ‘brain disease’ model of mental illness have argued that if we see depression and other mental disorders as real, physical diseases, people who have them will no longer be stigmatized as they were in the past. The idea is that if the problem is truly biological, it cannot be seen as a flaw in the character or will power of the person who suffers.

It’s a nice piece of reasoning. The problem is not only that it is not scientifically proven that depression, anxiety, and their ilk are biological diseases, but also that defining them in that way is as likely to create stigma as it is to destroy it.

That’s the argument made in a paper by Brett Deacon, a psychologist at the University of Wyoming, Laramie. Noting that Thomas Insel, the director of NIMH, had stated that “mental disorders are brain disorders,” the authors write:

“[W]e are concerned that the enthusiastic promotion of the brain disease model by NIMH and other prominent sources…has far outstripped the available scientific data and may actually be increasing the stigma associated with mental disorders.”

How could it be doing that? Well, the authors continue:

“Because biological models foster the perception that individuals with mental disorders lack control over their behavior, they may be viewed by others as unpredictable, dangerous, unable to care for themselves, requiring harsher treatment, and fundamentally different from those without mental disorders.”

In fact, there’s a whole literature of studies that find that biological explanations of mental disorder are associated with greater fear of and prejudice toward people who are in mental distress.

Such explanations can also influence the way that people with mental disorders view themselves. In an experiment they conducted at their university, Deacon and his lab members asked undergraduate participants “to imagine seeking help from a doctor who diagnosed them with major depressive disorder and provided either a brain disease or biopsychosocial explanation for their symptoms.”

They found that “[t]he brain disease explanation led to substantially less self-blame than the biopsychosocial explanation, but was associated with a worse expected prognosis, decreased self-efficacy in managing depression, and the perception that psychosocial interventions would be ineffective.”

That experiment and its conclusion rang true to me. Back in college, the biological explanation I was given for my experiences made me see myself more negatively. It made me feel nonsensical and unhinged, a view that gutted my self-esteem. Things didn’t change until years later, when I began to re-define what I’d been through not as a disease or an imbalance, but as a completely understandable interaction between my temperament—the person biology and life experience had made me—and the real stresses I had been under at the time.

Depression certainly isn’t a “flaw in character” or a “lack of will.” But the view that it is a well-defined brain disease is, at best, a leap. The scientific community acknowledges that the biological nature of depression is still not well understood. But Deacon's main point is that besides being iffy science, the brain disorder model isn't always good medicine, either. “It is possible," he writes, "that the brain disease model fosters beliefs about oneself, one’s disorder, and treatment that could interfere with clinical improvement.”

I couldn't agree more. By now, I know that while some people find the brain disease model comforting, others very much do not. Mental health care providers should be aware that this model isn't the all-purpose stigma-eraser it's sometimes presented to be—and they should be cautious about applying it to people whose needs it may not serve.

I agree with you that we shouldn't lie to people, but unfortunately, we've all been lied to quite a bit already. The author was actually pretty mild in saying that there isn't proof that mental illness is biological. There is increasing proof that it isn't. The "serotonin imbalance" theory of depression was substantially disproven back in the early 1980s. Same for the "dopamine theory" for psychosis. The most recent test of genetic risk factors for psychosis showed that those with the supposed risk factors were LESS likely to become psychotic than those that didn't have them.

There is no reason to believe that mental illnesses are entirely or primarily brain diseases. There is plenty of reason to believe that "mental illnesses" are merely a description of sets of annoying or difficult behavior or emotions that may have a wide range of causes, biological, psychological and spiritual. "Showing them the science" would only convince anyone who understands science that we have no idea whatsoever what causes "mental illness" or even whether or not they are "illnesses" at all.